Feature Article

Vertigo and migraine: ‘How can it be migraine if I don’t have a headache?’

Shaun Watson
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Vestibular migraine is a common, treatable cause of vertigo that should be considered whenever vertigo cannot be clearly explained by an alternative condition. In clinical practice, the patient’s response to treatment with a migraine preventive agent can determine the diagnosis.

Key Points

  • Vestibular migraine is one of the most common causes of vertigo but the diagnosis is still controversial in some circles.
  • Vestibular migraine is a protean disorder and should be considered whenever the clinical features of vertigo are not absolutely typical of an alternative diagnosis.
  • Although there can be strong clinical clues pointing to it, vestibular migraine is a diagnosis of exclusion.
  • If the patient presents with unilateral or asymmetrical hearing loss or tinnitus then a diagnosis of vestibular migraine should be questioned.
  • Treatment with a migraine preventive agent is usually effective and can determine the diagnosis.